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Keleş A, Kaya C. A comparison of pre- and post-operative outcomes in living donors undergoing transperitoneal laparoscopic nephrectomy and open nephrectomy: a retrospective single-center study. SAO PAULO MED J 2023; 142:e2022488. [PMID: 38088685 PMCID: PMC10708893 DOI: 10.1590/1516-3180.2022.0488.r1.070723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/05/2023] [Accepted: 07/07/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Kidney transplantation is often regarded as the preferred therapy for end-stage renal disease. Several surgical procedures have been developed to reduce postoperative donor complications, while maintaining kidney quality. OBJECTIVE This study aimed to compare the preoperative and postoperative outcomes of living kidney donors who underwent either transperitoneal laparoscopic nephrectomy or open nephrectomy. DESIGN AND SETTING Retrospective study conducted in Istanbul, Turkey. METHODS Fifty-five living-related kidney donors underwent nephrectomy and were retrospectively divided into two groups: 21 donors who underwent open nephrectomy (Group 1) and 34 donors who underwent transperitoneal laparoscopic nephrectomy (Group 2). RESULTS In comparison to the donors who underwent open nephrectomy, those who underwent transperitoneal laparoscopic nephrectomy had significantly shorter postoperative hospital stays (2.3 ± 0.2 versus 3.8 ± 0.8 days, P = 0.003), duration of urinary catheterization (1.2 ± 0.8 days versus 2.0 ± 0.7 days, P = 0.0001), operating times (210 ± 27 minutes versus 185 ± 24 minutes, P = 0.02), and less blood loss (86 ml versus 142 ml, P = 0.048). There was no statistically significant difference between the two groups with regard to the estimated blood transfusion and warm ischemia time. The preoperative week, first postoperative week, and 1-month postoperative serum creatinine levels were comparable between the groups. CONCLUSIONS Laparoscopic donor nephrectomy can be safely performed at centers with expertise in laparoscopic surgery. Laparoscopic donor nephrectomy has better outcomes than open donor nephrectomy in terms of length of hospital stay, duration of urinary catheterization, operating time, and blood loss.
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Affiliation(s)
- Ahmet Keleş
- MD. Urologist, Department of Urology, School of Medicine,
Istanbul Medeniyet University, Uskudar, Turkey
| | - Cevdet Kaya
- MD. Professor of Urology, Department of Urology, School of
Medicine, Marmara University, Istanbul, Turkey
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2
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Outcomes after 20 years of experience in minimally invasive living-donor nephrectomy. World J Urol 2022; 40:807-813. [DOI: 10.1007/s00345-021-03912-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022] Open
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3
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Robotic Assisted Living Donor Nephrectomies: A Safe Alternative to Laparoscopic Technique for Kidney Transplant Donation. Ann Surg 2020; 275:591-595. [PMID: 32657945 DOI: 10.1097/sla.0000000000004247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review outcomes after laparoscopic, robotic-assisted living donor nephrectomy (RLDN) in the first, and largest series reported to date. SUMMARY OF BACKGROUND DATA Introduction of minimal invasive, laparoscopic donor nephrectomy has increased live kidney donation, paving the way for further innovation to expand the donor pool with RLDN. METHODS Retrospective chart review of 1084 consecutive RLDNs performed between 2000 and 2017. Patient demographics, surgical data, and complications were collected. RESULTS Six patients underwent conversion to open procedures between 2002 and 2005, whereas the remainder were successfully completed robotically. Median donor age was 35.7 (17.4) years, with a median BMI of 28.6 (7.7) kg/m. Nephrectomies were preferentially performed on the left side (95.2%). Multiple renal arteries were present in 24.1%. Median operative time was 159 (54) minutes, warm ischemia time 180 (90) seconds, estimated blood loss 50 (32) mL, and length of stay 3 (1) days. The median follow-up was 15 (28) months. Complications were reported in 216 patients (19.9%), of which 176 patients (81.5%) were minor (Clavien-Dindo class I and II). Duration of surgery, warm ischemia time, operative blood loss, conversion, and complication rates were not associated with increase in body mass index. CONCLUSION RLDN is a safe technique and offers a reasonable alternative to conventional laparoscopic surgery, in particular in donors with higher body mass index and multiple arteries. It offers transplant surgeons a platform to develop skills in robotic-assisted surgery needed in the more advanced setting of minimal invasive recipient operations.
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4
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Arpalı E, Karataş C, Akyollu B, Yaprak D, Günaydın B, Koçak B. Hand-assisted laparoscopic donor nephrectomy in kidneys with multiple renal arteries versus a single renal artery: An analysis of vascular complications from 1,350 cases. Turk J Urol 2020; 46:tud.2020.19280. [PMID: 32449674 PMCID: PMC7360166 DOI: 10.5152/tud.2020.19280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/30/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Laparoscopic donor nephrectomy (LDN) has been shown to be a safe approach with better morbidity results. Impact of multiple renal arteries (MRAs) and anatomical variations has been reviewed by many authors. In our study, the relationship between the donors with MRAs and risk of perioperative vascular complications related to donor nephrectomy was investigated. MATERIAL AND METHODS Patients who underwent hand-assisted LDNs between January 2007 and February 2018 were reviewed retrospectively. Patient age, sex, body mass index (BMI), waist circumference, side of donor nephrectomies, donors with MRAs, intraoperative vascular complications, conversion rates, hospitalization durations, and operative times were extracted. Risk factors for perioperative vascular complications were defined. RESULTS There were MRAs in 288 kidney donors (21.3%). The number of patients who underwent a right donor nephrectomy was 113 (8.4%). BMI, waist circumference, and postoperative hospital stay were not significantly different between donors with one artery and those with MRAs (p>0.05). The renovascular complication rate and overall conversion rate to open surgery were significantly higher in donors with MRAs (p<0.05). CONCLUSION Perioperative safety of the kidney donors is of crucial importance. Surgeons performing LDNs must be aware of the potential risks. Our analysis suggests that procurement of kidneys from donors with MRAs is a risk factor for renovascular complications.
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Affiliation(s)
- Emre Arpalı
- Organ Transplant Center, Koç University Hospital, İstanbul, Turkey
| | - Cihan Karataş
- Organ Transplant Center, Koç University Hospital, İstanbul, Turkey
| | - Başak Akyollu
- Organ Transplant Center, Koç University Hospital, İstanbul, Turkey
| | - Doğukan Yaprak
- Organ Transplant Center, Koç University Hospital, İstanbul, Turkey
| | - Bilal Günaydın
- Department of Urology, Niğde Ömer Halis Demir University, Niğde, Turkey
| | - Burak Koçak
- Organ Transplant Center, Koç University Hospital, İstanbul, Turkey
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5
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Walker A, Slim N, Nicholson M, Brassett C. Configuration of the extra-renal venous system in relation to the left renal vein: A cadaveric study and new proposed classification. Surgeon 2020; 18:349-353. [PMID: 32089372 DOI: 10.1016/j.surge.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/14/2020] [Indexed: 11/18/2022]
Abstract
The advent of laparoscopic live-donor nephrectomy for renal transplantation has prompted the need to define the precise anatomical relations of the left renal vein (LRV) and its tributaries. The left kidney is preferred as the greater length of the LRV facilitates implantation in the recipient. While previous studies have described variations in the LRV system, the connections between the left ascending lumbar vein (LALV) and LRV tributaries have been less well-defined. This study aims to further characterise the LALV and proposes a novel classification for its relation to other veins. Dissection of the LRV system, including the left suprarenal vein (LSV), left gonadal vein (LGV) and LALV, was performed in 38 cadavers. Their drainage points into the LRV were recorded, and measurements taken of the distances from these points to the junction of the LRV and inferior vena cava (IVC). The position of the LRV in relation to the aorta was anterior in 35 cases (92%), entirely posterior in 1 case (3%), and circumaortic in 2 cases (5%). Duplication of the LSV and LGV occurred in 6 (16%) and 10 (27%) cases respectively. A direct posterior connection between the LALV and LRV was identified in 32 (86%) cases. The drainage point of the LALV into the LRV lay between the IVC and LGV in 8 (25%) cases. In 20 cases (63%), the drainage points of the LALV and LGV were equidistant from the IVC; and in 5 cases (16%), those of the LALV and posterior branch of the LRV were equidistant from the IVC. In these two groups, the vessels shared a confluent trunk in 10 and 4 cases respectively. In 3 cases, connections were observed between all three vessels (LALV, LGV and posterior branch of LRV). No confluence trunk was shared by the LALV and LSV. These results confirm the high incidence of communicating LALVs, which represent a potentially troublesome source of operative bleeding if unrecognised. Confluent venous trunks may also present difficulties during vessel ligation prior to nephrectomy. It is suggested that a novel classification of the relation of the LALV based on these findings may assist in surgical planning and reduce complications.
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Affiliation(s)
- Alexander Walker
- Department of Surgery, University of Cambridge, Cambridge, UK; Human Anatomy Teaching Group, Department of Physiology, Development and Neurosciences, University of Cambridge, Cambridge, UK.
| | - Naim Slim
- Human Anatomy Teaching Group, Department of Physiology, Development and Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Cecilia Brassett
- Human Anatomy Teaching Group, Department of Physiology, Development and Neurosciences, University of Cambridge, Cambridge, UK
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6
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Shin TY, Lee YS. Robot-assisted laparoscopic donor nephrectomy: surgical feasibility and technique. Heliyon 2019; 5:e02204. [PMID: 31428713 PMCID: PMC6695282 DOI: 10.1016/j.heliyon.2019.e02204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/22/2019] [Accepted: 07/29/2019] [Indexed: 12/20/2022] Open
Abstract
Background Laparoscopic donor nephrectomy (LDN) is currently accepted as the gold standard procedure for living donor nephrectomy. Robot-assisted LDN (RALDN), an evolving procedure, has recently shown potential to ultimately emerge as the preferred procedure. Here, we report our experience and the surgical technique followed for employing RALDN for living donation. Methods This retrospective study involved 56 consecutive patients who underwent RALDN between January 2015 and August 2018. Intraoperative and postoperative functional outcomes were analyzed and compared with the 45 patients who underwent hand-assisted LDN (HALDN) between May 2011 and December 2014. Results Mean procedure time for RALDN was 150 (range 90-210) min, and mean overall intraoperative blood loss was <100 (range 50-200) mL. Mean warm ischemic time recorded was 2 (range 1-5) min. Intraoperative complications, including blood transfusion or open conversion, did not occur in any patient. Conclusions The procedural results of RALDN were comparable or superior to HALDN. Our RALDN approach is safe and feasible, and the procedure appears to be significantly easier for the surgeon. We suggest that our findings be externally validated to reassure reproducibility of the measurement in a prospective evaluation.
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Affiliation(s)
- Tae Young Shin
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Yong Seong Lee
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
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7
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Trends in utilization and perioperative outcomes in live donor nephrectomies: a multi-surgical discipline analysis. World J Urol 2018; 37:2225-2230. [DOI: 10.1007/s00345-018-2559-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/03/2018] [Indexed: 10/27/2022] Open
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8
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Giacomoni A, Centonze L, Di Sandro S, Lauterio A, Ciravegna A, Buscemi V, Ferla F, Tripepi M, Concone G, De Carlis R, Colussi G, Gregorini M, De Carlis L. Robot-Assisted Harvesting of Kidneys for Transplantation and Global Complications for the Donor. Transplant Proc 2017; 49:632-637. [PMID: 28457361 DOI: 10.1016/j.transproceed.2017.02.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Arpali E, Aslan A, Scalea J, Karatas C, Akinci S, Altinel M, Kocak B. Living Kidney Donors With Adrenal Incidentalomas: Are They Appropriate Donors? Urology 2015; 87:100-5. [PMID: 26499786 DOI: 10.1016/j.urology.2015.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/18/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the incidence of adrenal incidentalomas (AIs) in a single-center series of living renal donors, to describe an evaluation algorithm for AIs in this patient population, and to compare the complication rates of hand-assisted laparoscopic donor nephrectomy (HALDN) with those of combined HALDN and adrenalectomy. METHODS We performed a single-center, retrospective study of consecutive living kidney donors who underwent laparoscopic nephrectomy for transplantation, with or without simultaneous ipsilateral adrenalectomy, between January 2008 and September 2014. RESULTS During the study period, AIs were detected in 18 of 1033 potential living renal donors who underwent computerized tomographic angiography. Application of additional donor selection criteria and of an adrenal mass assessment algorithm resulted in 849 HALDN, of which 13 were combined with simultaneous adrenalectomy. The hospital length of stay (2.4 vs 2.6 days), perioperative (0.025 vs 0.077), early (0.073 vs 0.077), and late (0.014 vs 0.077) postoperative complication rates, and conversion to open donor nephrectomy (0.008 vs 0.00) were not significantly different. Mean operative time was significantly longer in the adrenalectomy group. None of the adrenal masses were malignant. CONCLUSION Here, we presented our algorithm to manage the living kidney donors with AIs. Although donor population with AIs was relatively small in number, simultaneous adrenalectomy and ipsilateral nephrectomy seemed to be technically safe and conferred no identifiable increased risk of malignancy for the kidney transplant donor, when the incidentaloma is nonfunctional and less than or equal to 4 cm as assessed by preoperative imaging.
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Affiliation(s)
- Emre Arpali
- Department of Organ Transplantation, Memorial Sisli Hospital, Istanbul, Turkey.
| | - Atilla Aslan
- Department of Radiology, Memorial Sisli Hospital, Istanbul, Turkey
| | - Joseph Scalea
- Division of Transplantation, Department of Surgery and Urology, University of Wisconsin, Madison, WI
| | - Cihan Karatas
- Department of Organ Transplantation, Memorial Sisli Hospital, Istanbul, Turkey
| | - Serkan Akinci
- Department of Organ Transplantation, Turkish Kidney Foundation Hizmet Hospital, Istanbul, Turkey
| | - Mert Altinel
- Department of Urology, Turkish Kidney Foundation Hizmet Hospital, Istanbul, Turkey
| | - Burak Kocak
- Department of Organ Transplantation, Memorial Sisli Hospital, Istanbul, Turkey
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10
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Robotic nephrectomy for living donation: surgical technique and literature systematic review. Am J Surg 2015; 211:1135-42. [PMID: 26499052 DOI: 10.1016/j.amjsurg.2015.08.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 07/29/2015] [Accepted: 08/14/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND As compared with traditional laparoscopy, robotic-assisted surgery provides better EndoWrist instruments and three-dimensional visualization of the operative field. Studies published so far indicate that living donor nephrectomy using the robot-assisted technique is safe, feasible, and provides remarkable advantages for the patients. METHODS From 5 papers reporting detailed descriptions of surgical technique for robotic assisted nephrectomy (RAN) in living donor kidney transplantation, we have gathered information about the surgical techniques as well as about patients' intra- and postoperative outcome. Data from these articles were analyzed together with the data from our own experience (33 cases) so that the total number of analyzed cases was 292. RESULTS In the analyzed populations, no case of donor death occurred, and no case developed complication above grade 2 of Clavien score. Perioperative complications occurred in 37 of the 292 patients (12.6%). Accidental acute hemorrhage occurred in 5 of the 292 cases (1.7%). The average overall intraoperative blood loss was 67.8 mL (range 10 to 1,500). The average warm ischemia time was 3.5 minutes (range .58 to 7.6). Conversion to the open technique occurred in only 4 cases (1.3%). The average overall operative time was 192 minutes (range 60 to 400). The average length of the hospital stay was 2.7 days (range 1 to 10). CONCLUSIONS Safety and feasibility of RAN are pointed out in all the reviewed article, both as hand-assisted and as totally robotic technique. RAN appears to be significantly easier for the surgeons and the results are comparable with the ones obtained with the pure laparoscopic technique.
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11
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[Robotical laparoscopic nephrectomy for living donors]. Prog Urol 2015; 25:892-9. [PMID: 26471213 DOI: 10.1016/j.purol.2015.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 09/22/2015] [Accepted: 09/22/2015] [Indexed: 11/22/2022]
Abstract
Robotic surgery has been developed since the 2000s. Urology is the discipline that received the widest of the evolution of robotic surgery especially due to prostatectomy. Meanwhile kidney failure develops and kidney transplantation is unfortunately hampered by the number of cadaveric grafts available. Kidney living donation takes its rise, not including the development of minimally invasive surgery in which robotics has its place. We describe the environment of this development as well as the technique and the contribution of the operating nurse in the removal of kidney with the robotic approach in living donors.
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12
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13
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Giacomoni A, Di Sandro S, Lauterio A, Mangoni I, Mihaylov P, Concone G, Tripepi M, Poli C, Cusumano C, De Carlis L. Initial experience with robot-assisted nephrectomy for living-donor kidney transplantation: feasibility and technical notes. Transplant Proc 2014; 45:2627-31. [PMID: 24034009 DOI: 10.1016/j.transproceed.2013.07.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Robot-assisted surgery provide endowrist instruments and 3-dimensional visualization of the operative field that are improvements over traditional laparoscopy. The few research studies published so far have demonstrated that living-donor nephrectomy using the robot-assisted technique is safe and feasible, providing advantages for patients. METHODS Since November 2009, we performed 20 robot-assisted living-donor nephrectomies. Eight patients underwent hand-assisted robotic nephrectomy, whereas 20, totally robotic nephrectomy. RESULTS Median intraoperative bleeding was 174 mL (range, 10-750) but no patient needed intraoperative transfusion with blood cells. The median warm ischemia time was 3.16 minutes (range, 0.30-6.5). there was no case of conversion to an open procedure. The median operative time was 311 minutes (range, 85-530); the median console time was 160 minutes (range, 135-220). CONCLUSION Robot-assisted living-donor kidney recovery was a safe and effective procedure. The totally robotic recovery is an evolving technique. The prospect of robotic staplers, endowrist ligature, and robotic single port may further increase these advantages.
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Affiliation(s)
- A Giacomoni
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy.
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14
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Giacomoni A, Di Sandro S, Lauterio A, Concone G, Mangoni I, Mihaylov P, Tripepi M, De Carlis L. Evolution of robotic nephrectomy for living donation: from hand-assisted to totally robotic technique. Int J Med Robot 2014; 10:286-93. [PMID: 24599640 DOI: 10.1002/rcs.1576] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 11/27/2013] [Accepted: 01/02/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Alessandro Giacomoni
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
| | - Stefano Di Sandro
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
- Department of Surgical Sciences; University of Pavia; Italy
| | - Andrea Lauterio
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
| | - Giacomo Concone
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
- Department of Surgical Sciences; University of Pavia; Italy
| | - Iacopo Mangoni
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
| | - Plamen Mihaylov
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
| | - Matteo Tripepi
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
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15
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Warren J, da Silva V, Caumartin Y, Luke PPW. Robotic renal surgery: The future or a passing curiosity? Can Urol Assoc J 2013; 3:231-240. [PMID: 19543471 DOI: 10.5489/cuaj.1080] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The development, advancement and clinical integration of robotic technology in surgery continue at a staggering pace. In no other discipline has this rapid evolution occurred to a greater degree than in urology. Although radical prostatectomy has grown to become the prototypical application for the robot, the role of the robot in renal surgery remains controversial. Herein we review the literature on robotic renal surgery. A comprehensive PubMed literature search was performed to identify all published reports relating to robotic renal surgery. All clinically related articles involving human participants were critically appraised in this review. Fifty-one clinical articles were included, encompassing robot-assisted pyeloplasty, nephrectomy, nephroureterectomy, living-donor nephrectomy and partial nephrectomy. Feasibility has been shown for each of these procedures. Robot-assisted techniques have been described for almost all renal-related procedures. However, the intersect between feasibility and necessity as it pertains to robotic renal surgery has yet to be defined. Also, the high cost of surgical robotic technology mandates critical appraisal before adoption, especially in a publicly funded health care system, such as the one present in Canada.
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Affiliation(s)
- Jeff Warren
- Department of Surgery, Division of Urology, University of Western Ontario
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Friedersdorff F, Werthemann P, Cash H, Kempkensteffen C, Magheli A, Hinz S, Waiser J, Liefeldt L, Miller K, Deger S, Fuller TF. Outcomes after laparoscopic living donor nephrectomy: comparison of two laparoscopic surgeons with different levels of expertise. BJU Int 2012; 111:95-100. [DOI: 10.1111/j.1464-410x.2012.11348.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Peter Werthemann
- Department of Urology; Charité Universitätsmedizin Berlin; Berlin
| | - Hannes Cash
- Department of Urology; Charité Universitätsmedizin Berlin; Berlin
| | | | - Ahmed Magheli
- Department of Urology; Charité Universitätsmedizin Berlin; Berlin
| | - Stefan Hinz
- Department of Urology; Charité Universitätsmedizin Berlin; Berlin
| | - Johannes Waiser
- Department of Nephrology; Charité Universitätsmedizin Berlin; Berlin
| | - Lutz Liefeldt
- Department of Nephrology; Charité Universitätsmedizin Berlin; Berlin
| | - Kurt Miller
- Department of Urology; Charité Universitätsmedizin Berlin; Berlin
| | - Serdar Deger
- Department of Urology; Paracelsus-Krankenhaus Ruit; Ostfildern; Germany
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17
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Meng OYL, Lim C, Leng CW, van der Erf S, Joshi VD, Sin ST, Hong STS, Chye PGS, Seng GTC. Factors Influencing Living Kidney Donation in Singapore. Prog Transplant 2012; 22:95-101. [DOI: 10.7182/pit2012607] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Context— Kidney transplantation is the best treatment option for kidney failure, but the supply of donor kidneys remains small. Objective— To understand the public's attitude toward living donor kidney donation in Singapore. Design, Setting and Participants, Intervention, Outcome Measures— A cross-sectional study of a convenience sample of 1520 members of the general public seeking care at local medical centers. A self-administered questionnaire included questions on demographics and subjects' willingness and unwillingness to donate a kidney. Respondents were aged at least 18 years and did not have underlying chronic kidney disease, end-stage renal disease requiring dialysis, or history of kidney transplant. Results— Overall mean age of respondents was 49 (SD, 15) years and 50% were male. Response rate to the question on “willingness to donate kidney while alive” was 96% (1460); 707 (48.4%) were willing to donate a kidney while alive. Respondents who were willing to donate were younger (<40 years; P < .001); had above a secondary level education ( P < .001); had monthly household income 2000 SGD (or US$1660; exchange rate at 1 SGD = US$0.83) or higher ( P< .001); were not married, single, or divorced ( P< .001); and were professionals ( P< .001). Fear of surgical risks (86.5% strongly agree or agree) and poorer health consequent to donation (87.5% strongly agree or agree) were the main reasons for not considering being a living kidney donor. Demographic factors and concerns of surgical risks and ill health after transplant influenced willingness to donate a kidney while alive. Addressing these concerns may alleviate anxiety with regard to living kidney donation.
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Affiliation(s)
- Ow Yong Lai Meng
- MMed, FCFP, GDip, Terence Kee Yi-Shern, BMBS, MRCP, FAMS Singapore General Hospital (OYLM, CL, TKYS), Centre for Health Services Research, Singapore Health Services (CWL, SvdE, VDJ), SingHealth Polyclinics (STS, STSH, PGSC, GTCS)
| | - Crystal Lim
- MMed, FCFP, GDip, Terence Kee Yi-Shern, BMBS, MRCP, FAMS Singapore General Hospital (OYLM, CL, TKYS), Centre for Health Services Research, Singapore Health Services (CWL, SvdE, VDJ), SingHealth Polyclinics (STS, STSH, PGSC, GTCS)
| | - Chow Wai Leng
- MMed, FCFP, GDip, Terence Kee Yi-Shern, BMBS, MRCP, FAMS Singapore General Hospital (OYLM, CL, TKYS), Centre for Health Services Research, Singapore Health Services (CWL, SvdE, VDJ), SingHealth Polyclinics (STS, STSH, PGSC, GTCS)
| | - Saskia van der Erf
- MMed, FCFP, GDip, Terence Kee Yi-Shern, BMBS, MRCP, FAMS Singapore General Hospital (OYLM, CL, TKYS), Centre for Health Services Research, Singapore Health Services (CWL, SvdE, VDJ), SingHealth Polyclinics (STS, STSH, PGSC, GTCS)
| | - Veena D. Joshi
- MMed, FCFP, GDip, Terence Kee Yi-Shern, BMBS, MRCP, FAMS Singapore General Hospital (OYLM, CL, TKYS), Centre for Health Services Research, Singapore Health Services (CWL, SvdE, VDJ), SingHealth Polyclinics (STS, STSH, PGSC, GTCS)
| | - Swah Teck Sin
- MMed, FCFP, GDip, Terence Kee Yi-Shern, BMBS, MRCP, FAMS Singapore General Hospital (OYLM, CL, TKYS), Centre for Health Services Research, Singapore Health Services (CWL, SvdE, VDJ), SingHealth Polyclinics (STS, STSH, PGSC, GTCS)
| | - Stephanie Teo Swee Hong
- MMed, FCFP, GDip, Terence Kee Yi-Shern, BMBS, MRCP, FAMS Singapore General Hospital (OYLM, CL, TKYS), Centre for Health Services Research, Singapore Health Services (CWL, SvdE, VDJ), SingHealth Polyclinics (STS, STSH, PGSC, GTCS)
| | - Paul Goh Soo Chye
- MMed, FCFP, GDip, Terence Kee Yi-Shern, BMBS, MRCP, FAMS Singapore General Hospital (OYLM, CL, TKYS), Centre for Health Services Research, Singapore Health Services (CWL, SvdE, VDJ), SingHealth Polyclinics (STS, STSH, PGSC, GTCS)
| | - Gilbert Tan Choon Seng
- MMed, FCFP, GDip, Terence Kee Yi-Shern, BMBS, MRCP, FAMS Singapore General Hospital (OYLM, CL, TKYS), Centre for Health Services Research, Singapore Health Services (CWL, SvdE, VDJ), SingHealth Polyclinics (STS, STSH, PGSC, GTCS)
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Morbidity of 200 consecutive cases of hand-assisted laparoscopic living donor nephrectomies: a single-center experience. J Transplant 2012; 2012:121523. [PMID: 22530106 PMCID: PMC3316965 DOI: 10.1155/2012/121523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 12/13/2011] [Indexed: 01/10/2023] Open
Abstract
Background. Recipients of laparoscopically procured kidneys have been reported to have delayed graft function, a slower creatinine nadir, and potential significant complications. As the technique has evolved laparoscopic donor nephrectomy technique is becoming the gold standard for living donation. Study Design. We retrospectively reviewed the data of the first 200 hand-assisted laparoscopic living donor nephrectomies performed between January 2003 and February 2009. The initial 41 donors and their recipients (Group 1) were compared to the next 159 donors and their recipients (Group 2). The estimated blood loss, serum creatinine at discharge and 6 months, and the incidence of delayed graft function and perioperative complications were analyzed. Results. The median donor serum creatinine at discharge and 6 months was 1.2 mg/dL in each group. None of the laparoscopic procedures required conversion to an open procedure, and none of the donors required perioperative blood transfusion. The median recipient serum creatinine at 6 months after transplant was 1.2 mg/dL for each group. No ischemic ureteral complications related to the laparoscopic technique were seen. Conclusions. HALDN with meticulous surgical technique allows kidney procurement with very low morbidity and no mortality. This improved safety and decreased invasiveness from laparoscopic approach may further decrease morbidity of the procedure and increase organ donation.
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Vascular Constraints in Laparoscopic Renal Allograft: Comparative Analysis of Multiple and Single Renal Arteries in 976 Laparoscopic Donor Nephrectomies. World J Surg 2011; 35:2159-66. [DOI: 10.1007/s00268-011-1168-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Li G, Dong J, Lu JS, Zu Q, Yang SX, Li HZ, Ma X, Zhang X. Anatomical variation of the posterior lumbar tributaries of the left renal vein in retroperitoneoscopic left living donor nephrectomy. Int J Urol 2011; 18:503-9. [DOI: 10.1111/j.1442-2042.2011.02778.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Laparoscopic Living-Donor Nephrectomy: Analysis of the Existing Literature. Eur Urol 2010; 58:498-509. [DOI: 10.1016/j.eururo.2010.04.003] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 04/07/2010] [Indexed: 01/10/2023]
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Kocak B, Baker TB, Koffron AJ, Leventhal JR. Ureteral complications in the era of laparoscopic living donor nephrectomy: do we need to preserve the gonadal vein with the specimen? J Endourol 2010; 24:247-51. [PMID: 20059394 DOI: 10.1089/end.2009.0414] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE The aim of this study was to analyze the ureteral complication rate in recipients transplanted with laparoscopically retrieved kidneys in our institution's 8-year experience when the gonal vein was not preserved with the specimen during the donor procedure. PATIENTS AND METHODS We reviewed the records of 800 consecutive laparoscopic donor nephrectomy patients. Donor sex, age, body mass index, warm ischemia time, hospital length of stay, donor and recipient serum creatinine levels, and incidence and type of complications including the incidence of ureteral complications were recorded. RESULTS Mean patient age was 39 +/- 10 years. Mean body mass index was 27 +/- 5. A total of 482 cases were treated purely laparoscopically. Of them, 318 were performed hand assisted. Seven hundred and ninety-three procedures were done on the left side and seven were done on the right side. The overall rate of intraoperative complications was 2.9%. The overall open conversion rate was 1.4%. The overall rate of postoperative complications was 3.9%. The postoperative day-7 serum creatinine values of the donors were 1.4 +/- 0.3 mg/dL. Mean creatinine in all patients at 1 week after transplantation was 1.5 +/- 0.2 mg/dL. We had one case of ureteral stricture in the recipients of laparoscopically procured kidneys without gonadal vein preservation technique among 800 patients. CONCLUSION Gonadal vein preservation with the entire specimen during laparoscopic donor nephrectomy procedure is not a necessary step to protect periureteral blood supply to prevent ureteral strictures.
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Affiliation(s)
- Burak Kocak
- Department of Urology and Organ Transplantation, Memorial Hospital, Istanbul, Turkey.
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23
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Dols LFC, Kok NFM, IJzermans JNM. Live donor nephrectomy: a review of evidence for surgical techniques. Transpl Int 2010; 23:121-30. [DOI: 10.1111/j.1432-2277.2009.01027.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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24
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Laparoscopic-assisted distal pancreatectomy and nephrectomy from a live donor. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2010; 17:193-6. [DOI: 10.1007/s00534-009-0247-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Accepted: 10/16/2009] [Indexed: 10/19/2022]
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25
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Leventhal JR, Paunescu S, Baker TB, Caciedo JC, Skaro A, Kocak B, Gallon L, Friedewald J, Luo X, Kaufman DB, Fryer JP, Abecassis MM. A decade of minimally invasive donation: experience with more than 1200 laparoscopic donor nephrectomies at a single institution. Clin Transplant 2010; 24:169-74. [DOI: 10.1111/j.1399-0012.2009.01199.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Louis G, Hubert J, Ladriere M, Frimat L, Kessler M. Transplantation rénale à partir de donneurs vivants prélevés sous laparoscopie assistée par robot. À propos d’une série de 35 cas. Nephrol Ther 2009; 5:623-30. [DOI: 10.1016/j.nephro.2009.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 06/21/2009] [Accepted: 06/22/2009] [Indexed: 01/10/2023]
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Cavallari G, Tsivian M, Neri F, Bertelli R, Faenza A, Nardo B. Hand-Assisted Laparoscopic Donor Nephrectomy: Analysis of the Learning Curve in a Training Model In Vivo. Transplant Proc 2009; 41:1125-7. [DOI: 10.1016/j.transproceed.2009.02.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Nogueira JM, Haririan A, Jacobs SC, Weir MR, Hurley HA, Al-Qudah HS, Phelan M, Drachenberg CB, Bartlett ST, Cooper M. The detrimental effect of poor early graft function after laparoscopic live donor nephrectomy on graft outcomes. Am J Transplant 2009; 9:337-47. [PMID: 19067659 DOI: 10.1111/j.1600-6143.2008.02477.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We undertook this study to assess the rate of poor early graft function (EGF) after laparoscopic live donor nephrectomy (lapNx) and to determine whether poor EGF is associated with diminished long-term graft survival. The study population consisted of 946 consecutive lapNx donors/recipient pairs at our center. Poor EGF was defined as receiving hemodialysis on postoperative day (POD) 1 through POD 7 (delayed graft function [DGF]) or serum creatinine >/= 3.0 mg/dL at POD 5 without need for hemodialysis (slow graft function [SGF]). The incidence of poor EGF was 16.3% (DGF 5.8%, SGF 10.5%), and it was stable in chronologic tertiles. Poor EGF was independently associated with worse death-censored graft survival (adjusted hazard ratio (HR) 2.15, 95% confidence interval (CI) 1.34-3.47, p = 0.001), worse overall graft survival (HR 1.62, 95% CI 1.10-2.37, p = 0.014), worse acute rejection-free survival (HR 2.75, 95% CI 1.92-3.94, p < 0.001) and worse 1-year renal function (p = 0.002). Even SGF independently predicted worse renal allograft survival (HR 2.54, 95% CI 1.44-4.44, p = 0.001). Risk factors for poor DGF included advanced donor age, high recipient BMI, sirolimus use and prolonged warm ischemia time. In conclusion, poor EGF following lapNx has a deleterious effect on long-term graft function and survival.
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Affiliation(s)
- J M Nogueira
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
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Mitre AI, Dénes FT, Nahas WC, Simões FA, Colombo JR, Piovesan AC, Chambô JL, Arap S, Srougi M. Comparative and prospective analysis of three different approaches for live-donor nephrectomy. Clinics (Sao Paulo) 2009; 64:23-8. [PMID: 19142547 PMCID: PMC2671972 DOI: 10.1590/s1807-59322009000100005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 09/17/2008] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Living donor nephrectomy is usually performed by a retroperitoneal flank incision. Due to the significant morbidity and long recovery time for a flank incision, anterior extra peritoneal sub-costal and transperitoneal video-laparoscopic methods have been described for donor nephrectomy. We prospectively compare the long-term results of donors as well as functional recipients submitted to these three approaches. MATERIALS AND METHODS A total of 107 live donor renal transplantations were prospectively evaluated from May 2001 to January 2004. Donors were compared with regard to operative and warm ischemia time, postoperative pain, analgesic requirements, and complications. Recipients were compared with regard to graft function, acute cellular rejection, surgical complications, and graft and recipient survival. RESULTS The mean operative and warm ischemia times were longer in the video-laparoscopic group (p<0.001), whereas patients of the flank incision group presented more postoperative pain (p=0.035), required more analgesics (p<0.001), had longer hospital stays (p<0.001), and suffered more pain on the 90th day after surgery (p=0.006). In the sub-costal and flank incision groups, there was a larger number of paraesthesias and abdominal wall asymmetries (p<0.001). Recipient groups were demographically comparable and presented similar acute tubular necrosis incidence and delayed graft function. The incidence of acute cellular rejection was higher in the video-laparoscopic and flank incision groups (p=0.013). There was no difference in serum creatinine levels, surgical complications, or recipient or graft survival between groups. CONCLUSIONS The video-laparoscopic and sub-costal approaches proved to be safe, and to provide donor advantages relative to the flank incision approach. Among recipients, the complication rate, graft survival, and recipient survival were similar in all groups.
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Affiliation(s)
- Anuar Ibrahim Mitre
- Department of Urology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Abstract
Since it first was performed in 1995, laparoscopic donor nephrectomy (LDN) has grown to be the standard of care in most transplant centers in the United States. This article reviews the current indications, selection criteria, surgical approaches, outcomes, and complications of LDN.
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Affiliation(s)
- David A Duchene
- Department of Urology, University of Kansas Medical Center, MS 3016, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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31
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Comparison of CT Angiography With MR Angiography in the Preoperative Assessment of Living Kidney Donors. Transplantation 2008; 86:1249-56. [DOI: 10.1097/tp.0b013e3181890810] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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32
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Nogueira JM, Jacobs SC, Haririan A, Phelan MW, Weir MR, Seliger SL, Hurley HA, Cooper M. A single center comparison of long-term outcomes of renal allografts procured laparoscopically versus historic controls procured by the open approach. Transpl Int 2008; 21:908-14. [DOI: 10.1111/j.1432-2277.2008.00687.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Cavallari G, Tsivian M, Bertelli R, Neri F, Faenza A, Nardo B. A New Swine Training Model of Hand-Assisted Donor Nephrectomy. Transplant Proc 2008; 40:2035-7. [DOI: 10.1016/j.transproceed.2008.05.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND There is an ongoing discussion in living renal transplantation whether the right or the left donor nephrectomy is to be preferred if both kidneys are equal, due to the lack of prospective studies. METHODS A prospective single-center randomized trial was conducted from April 2002 to September 2006, in which 60 eligible consecutive donors were randomized to either left-sided or right-sided hand-assisted laparoscopic donor nephrectomy (HALDN). Primary endpoint was operation time. Secondary endpoints were donor morbidity, warm ischemia time, delayed graft function, urological complications, quality of life, and graft survival. RESULTS Median operating time for left-sided HALDN (180 min) was significantly longer compared with right-sided HALDN (150 min; P=0.021). There were no conversions in both groups. There were no major intra- or postoperative complications. One-year graft survival rate was 96% in the left group versus 93% in the right group (P=0.625, log rank). CONCLUSIONS Operating time of HALDN of the right kidney is significantly shorter than HALDN of the left kidney. No differences were detected in complication rates and graft survival between left and right-sided donor nephrectomy.
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Laparoscopic Living Donor Nephrectomy: A Single-Center Sequential Experience Comparing Hand-Assisted Versus Standard Technique. Urology 2007; 70:1060-3. [DOI: 10.1016/j.urology.2007.07.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Revised: 05/17/2007] [Accepted: 07/03/2007] [Indexed: 11/21/2022]
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37
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Kok NFM, IJzermans JNM, Schouten O, Tran KTC, Weimar W, Alwayn IPJ. Laparoscopic donor nephrectomy in obese donors: easier to implement in overweight women? Transpl Int 2007; 20:956-61. [PMID: 17635838 DOI: 10.1111/j.1432-2277.2007.00522.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Laparoscopic donor nephrectomy (LDN) has been proven feasible in overweight individuals, but remains technically challenging. As the perirenal fat distribution and consistency significantly differ between men and women, we investigated possible differences between the genders. Prospectively collected data of 37 female and 39 male donors with a body mass index (BMI) over 27 who underwent total LDN were compared. Ninety-one donors with a BMI <25 served as controls. Clinically relevant differences were not observed between men and women of normal weight. In overweight donors, two (5%) procedures were converted to open in females and five (13%) in males. None of these conversions in females, but four conversions in males, appeared to be related to the donor's perirenal fat (P = 0.05). Operation time (median 210 vs. 241 min, P = 0.01) and blood loss (median 100 vs. 200 ml, P = 0.04) were favorable in female donors. The number of complications did not significantly differ. Total LDN in overweight female donors does not lead to increased operation times, morbidity or technical complications. In contrast, the outcome in obese males seems to be less advantageous, indicating that total LDN in overweight women can be advocated as a routine procedure but in obese men reluctance seems justified.
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Affiliation(s)
- Niels F M Kok
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
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38
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Hadjianastassiou VG, Johnson RJ, Rudge CJ, Mamode N. 2509 living donor nephrectomies, morbidity and mortality, including the UK introduction of laparoscopic donor surgery. Am J Transplant 2007; 7:2532-7. [PMID: 17868058 DOI: 10.1111/j.1600-6143.2007.01975.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The worldwide expansion of laparoscopic, at the expense of open, donor nephrectomy (DN) has been driven on the basis of faster convalescence for the donor. However, concerns have been expressed over the safety of the laparoscopic procedure. The UK Transplant National Registry collecting mandatory information on all living kidney donations in the country was analyzed for donations between November 2000 (start of living donor follow-up data reporting) to June 2006 to assess the safety of living DN, after the recent introduction of the laparoscopic procedure in the United Kingdom. Twenty-four transplant units reported data on 2509 donors (601 laparoscopic, 1800 open and 108 [4.3%] unspecified); 46.5% male; mean donor age: 46 years. There was one death 3 months postdischarge and a further five deaths beyond 1 year postdischarge. The mean length of stay was 1.5 days less for the laparoscopic procedure (p < 0.001). The risk of major morbidity for all donors was 4.9% (laparoscopic = 4.5%, open = 5.1%, p = 0.549). The overall rate of any morbidity was 14.3% (laparoscopic = 10.3%, open = 15.7%, p = 0.001). Living donation has remained a safe procedure in the UK during the learning curve of introduction of the laparoscopic procedure. The latter offers measurable advantages to the donor in terms of reduced length of stay and morbidity.
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Affiliation(s)
- V G Hadjianastassiou
- Directorate of Nephrology, Transplantation and Urology, Level 6, New Guy's House, Guy's Hospital, St. Thomas' Street, London SE1 9RT, UK.
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Morrisroe SN, Wall RT, Lu AD. Unilateral pulmonary edema after laparoscopic donor nephrectomy: report of two cases. J Endourol 2007; 21:760-2. [PMID: 17705766 DOI: 10.1089/end.2006.0321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Unilateral pulmonary edema of the dependent lung presented after laparoscopic living-donor nephrectomy in two patients. Treatment with O(2) supplementation and diuretics resulted in relief of symptoms and radiographic improvement. The presumed causes of this previously unreported complication of laparoscopic living donor nephrectomy include prolonged lateral decubitus positioning and high fluid requirements.
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Affiliation(s)
- Shelby N Morrisroe
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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40
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Hubert J, Renoult E, Mourey E, Frimat L, Cormier L, Kessler M. Complete robotic-assistance during laparoscopic living donor nephrectomies: An evaluation of 38 procedures at a single site. Int J Urol 2007; 14:986-9. [DOI: 10.1111/j.1442-2042.2007.01876.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Feifer A, Anidjar M. [Laparoscopic nephrectomy in a living donor]. ANNALES D'UROLOGIE 2007; 41:158-172. [PMID: 18260606 DOI: 10.1016/j.anuro.2007.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Kidney transplantation is the therapeutic option of choice for patients with end-stage renal disease. With the advent of safer harvesting techniques and immunosuppression, both donor and recipient outcomes have markedly improved in recent years. Kidney donation from Living donors remains the single most important factor responsible for improving patient and graft survival. The laparoscopic donor nephrectomy has revolutionized renal transplantation, allowing expansion of the donor pool by diminishing surgical morbidity while maintaining equivalent recipient outcome. This technique is now becoming the gold-standard harvesting procedure in transplant centres worldwide, despite its technical challenge and ongoing procedural maturation, especially early in the learning curve. Previous contraindications to laparoscopic donor nephrectomy are no longer absolute. In the following analysis, the procedural aspects of the laparoscopic donor nephrectomy are detailed including pre-operative assessment, operative technique and a review of the current literature delineating aspects of both donor and recipient morbidity and mortality compared with open harvesting techniques.
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Affiliation(s)
- A Feifer
- McGill University Health Center, Royal Victoria Hospital, Department of urology, S6.88 Pine Avenue West, Montréal, Québec, Canada
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42
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Paul A, Treckmann J, Gallinat A, Witzke O, Vester U, Broelsch CE. Current concepts in transplant surgery: laparoscopic living donor of the kidney. Langenbecks Arch Surg 2007; 392:501-9. [PMID: 17530281 DOI: 10.1007/s00423-007-0192-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2006] [Accepted: 12/06/2006] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Living donor kidney transplantation has emerged as an excellent alternative to cadaveric donation since, more than 50 years ago, the first live donor nephrectomy was successfully performed. OBJECTIVE The basic idea of introducing laparoscopy in live donor nephrectomy was to obtain a potential reduction in incision-related morbidity with reduced pain and faster reconvalescence while providing at least the same level of operative security. This paper is focusing on technical aspects, outcome, results, and possible current concerns and advantages of laparoscopic living-related donor nephrectomy. CONCLUSION According to our results and the results available in the literature, laparoscopic living donor nephrectomy is safe when performed with sufficient experience. Postoperative pain is less and recovery is significantly faster.
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Affiliation(s)
- Andreas Paul
- Clinic for General, Visceral and Transplantation Surgery, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.
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Strang AM, Lockhart ME, Kenney PJ, Amling CL, Urban DA, El-Galley R, Burns JR, Colli JL, Hammontree LN, Kolettis PN. Computerized tomographic angiography for renal donor evaluation leads to a higher exclusion rate. J Urol 2007; 177:1826-9. [PMID: 17437828 DOI: 10.1016/j.juro.2007.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE We compared the exclusion rate for potential living renal donors evaluated with computerized tomography angiography and radionuclide renal scintigraphy (renal scan) vs excretory urogram, renal scan and renal arteriography. MATERIALS AND METHODS From March 2004 through February 2006, 603 consecutive patients were evaluated as potential living renal donors. From March 2004 through February 2005, 270 consecutive patients underwent evaluation with excretory urogram, renal scan and renal angiography (group 1). Of these patients 16 underwent computerized tomography to evaluate abnormalities detected on excretory urogram. From March 2005 through February 2006, 333 consecutive patients underwent evaluation with computerized tomography angiography and renal scan (group 2). The number of patients excluded for medical reasons and/or radiographic abnormalities was determined for the 2 groups. RESULTS More than twice as many patients evaluated with computerized tomography were excluded. In group 1, 7% of patients (20 of 270) were excluded from donation due to radiographic findings vs 16% (53 of 333) in group 2 (p=0.0016). Of the patients 26% and 23% were excluded from renal donation for medical reasons in groups 1 and 2, respectively (p=0.5059). CONCLUSIONS Multidetector row computerized tomography angiography increases the detection of incidental radiographic abnormalities as well as the renal donor exclusion rate. The increased sensitivity of computerized tomography angiography has created a dilemma for those determining patient eligibility for kidney donation because the clinical significance of many of these findings is unclear. Additional studies should address the significance of these incidental findings so that patients are not needlessly excluded from kidney donation.
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Affiliation(s)
- Andrew M Strang
- Division of Urology, University of Alabama at Birmingham, Birmingham, Alabama 35294-3296, USA
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Martin GL, Guise AI, Bernie JE, Bargman V, Goggins W, Sundaram CP. Laparoscopic Donor Nephrectomy: Effects of Learning Curve on Surgical Outcomes. Transplant Proc 2007; 39:27-9. [PMID: 17275468 DOI: 10.1016/j.transproceed.2006.10.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Indexed: 11/20/2022]
Abstract
UNLABELLED Our objective was to determine the effect of an experienced laparoscopic surgeon's learning curve with laparoscopic donor nephrectomy (LDN) on patient outcome and graft function. MATERIALS AND METHODS Retrospective review of the medical records of the initial 73 consecutive LDN patients and corresponding transplant recipients was performed. All of the LDN were performed by a single, experienced laparoscopic surgeon (C.P.S.). The method of LDN was slightly different between the groups. RESULTS Patients were divided into early and late groups with 37 and 36 patients, respectively. There was no statistically significant difference in mean estimated blood loss (245 +/- 671.2 vs 84.7 +/- 63.9 mL), warm ischemia time (159.7 +/- 66.3 vs 150.8 +/- 63.0 seconds), postoperative creatinine levels (1.34 +/- 0.24 vs 1.29 +/- 0.26 mg/dL,), recipient mean creatinine level at 1 month (1.57 +/- .98 vs 1.53 +/- 0.46 mg/dL), and hospital stay (2.49 +/- 0.87 vs 2.47 +/- 0.56 days) between the early and late groups. However, the difference in mean operative time between early and late groups was statistically significant (255.2 +/- 42.4 vs. 209.1 +/- 30.8 minutes, P < .05). In addition, there were 8 (21.6%) vs 4 (11.1%) instances of slow graft function and 3 (8.1%) vs 0 instances of delayed graft function among the recipients in early group versus the late group. There were four (10.8%) vs two (5.6%) minor complications among donors of the early and late groups, respectively. CONCLUSION There is a significant decrease in operating time and incidence of delayed graft function following the first 37 patients who underwent LDN by an experienced laparoscopist. Improvement in operative technique decreased operative time and improved perioperative graft function as evidenced by decreased slow graft function and delayed graft function in the late group.
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Affiliation(s)
- G L Martin
- Indiana University Department of Urology, Indianapolis, IN 46202-5289, USA
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Schlunt LB, Harper JD, Broome DR, Baron PW, Watkins GE, Ojogho ON, Baldwin DD. Improved Detection of Renal Vascular Anatomy Using Multidetector CT Angiography: Is 100% Detection Possible? J Endourol 2007; 21:12-7. [PMID: 17263601 DOI: 10.1089/end.2006.0257] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Multidetector CT angiography (MDCTA) is being used increasingly to evaluate vascular anatomy prior to donor nephrectomy. To improve the ability of MDCTA to predict donor renal anatomy, a novel protocol including four-phase imaging with three-dimensional reconstruction and maximum intensity projections (MIPs) was incorporated into the standard donor evaluation. The purpose of this study was to determine the results of this protocol. PATIENTS AND METHODS Seventy consecutive patients who underwent hand-assisted laparoscopic donor nephrectomy between January 2003 and September 2004 were reviewed. All MDCTA studies were examined initially by a radiologist alone, after which, a second preoperative reading was performed by a radiologist and the operating surgeon together. The two reviews were compared with the operative findings. RESULTS Using this protocol to detect the total number of renal arteries, veins, and ureters, the sensitivity of the initial radiologist was 97%, 100%, and 96%, respectively. These values increased to 100%, 100%, and 99% when the films were reviewed by a radiologist together with the surgeon who would operate on the donor. The sensitivity, specificity, and accuracy in predicting supernumerary arteries, including early (< or =1-cm) arterial branching was 89%, 100%, and 97%, respectively after the single reading but increased to 100%, 100%, and 100% with the combined reading. CONCLUSIONS An MDCTA study with this protocol provides excellent anatomic detail prior to donor nephrectomy. Its ability to predict renal-arterial and ureteral anatomy is enhanced when the films are reviewed simultaneously by a radiologist and the operating surgeon.
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Affiliation(s)
- Lori B Schlunt
- Division of Urology, Loma Linda University Medical Center, Loma Linda, California 92354, USA
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Schlunt LB, Harper JD, Broome DR, Baron PW, Watkins GE, Ojogho ON, Baldwin DD. Multidetector Computerized Tomography Angiography to Predict Lumbar Venous Anatomy Before Donor Nephrectomy. J Urol 2006; 176:2576-81; discussion 2581. [PMID: 17085162 DOI: 10.1016/j.juro.2006.07.160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE Multidetector computerized tomography angiography has been used to predict renal anatomy before donor nephrectomy. Unrecognized lumbar veins represent a significant risk during laparoscopic surgery but to our knowledge no previous group has attempted to predict lumbar veins with multidetector computerized tomography angiography before laparoscopic donor nephrectomy. We evaluated the ability of multidetector computerized tomography angiography to preoperatively predict the size and location of anomalous left lumbar veins. MATERIALS AND METHODS A prospective study was performed in patients undergoing left hand assisted laparoscopic donor nephrectomy from January 2003 to September 2004. All patients were imaged using 4-phase computerized tomography, including computerized tomography angiography with 1.25 mm collimation of the arterial and venous phases. Each multidetector computerized tomography angiogram was prospectively reviewed by a radiologist and operating surgeon, and retrospectively reviewed by a second blinded radiologist. RESULTS A total of 70 patients underwent left hand assisted laparoscopic donor nephrectomy between January 2003 and September 2004. Five patients underwent imaging elsewhere and were excluded from study. Of the remaining 65 patients 54 (83%) had at least 1 anomalous lumbar vein of any size recognized at surgery. Additionally, 33 of these 65 patients (51%) had an anomalous lumbar vein that was 3 mm or greater. These 3 mm or greater vessels carry a significant risk of bleeding and they were used in further calculations. As read by a radiologist and surgeon, the sensitivity and specificity of multidetector computerized tomography angiography compared to surgical identification were 97% and 91%, respectively. Positive and negative predictive values, and accuracy were 91.4%, 97% and 94%, respectively. CONCLUSIONS Multidetector computerized tomography angiography accurately predicts lumbar venous anatomy before donor nephrectomy with high sensitivity, specificity and accuracy.
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Affiliation(s)
- Lori B Schlunt
- Division of Urology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354, USA
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Gorodner V, Horgan S, Galvani C, Manzelli A, Oberholzer J, Sankary H, Testa G, Benedetti E. Routine left robotic-assisted laparoscopic donor nephrectomy is safe and effective regardless of the presence of vascular anomalies. Transpl Int 2006; 19:636-40. [PMID: 16827680 DOI: 10.1111/j.1432-2277.2006.00315.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The classic approach to donor nephrectomy consists of preferential procurement of the kidney without vascular anomalies. We studied the effect of routine procurement of the left kidney regardless the presence of multiple arteries on the outcomes of robotic-assisted laparoscopic living donor nephrectomy (LLDN) with particular reference to the incidence of urological complications. From August 2000 to July 2005, 209 left LLDNs were performed. We analyzed the outcomes of donors and recipients in relation to the presence of multiple vessels versus normal anatomy. We divided the patients into two groups: group A (n = 148) with normal vascular anatomy and group B (n = 61) with vascular anomalies. In the donors, no significant difference in conversion to open surgery rate, blood loss, length of stay, was noted between the two groups; operative time and warm ischemia time were slightly higher in group B. One-year patient survival was 98% in both groups while the 1-year graft survival was 96.6% in group A and 96% in group B. Only one urological complication was noted in the group with normal anatomy (0.7%) versus none in the group with multiple arteries. Left kidney procurement using robotic-assisted laparoscopic technique is safe and effective, even in the presence of vascular anomalies.
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Affiliation(s)
- Verónica Gorodner
- Division of General Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA
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Abstract
Laparoscopic donor nephrectomy has become the accepted method of harvesting the kidney at many institutions because of multiple advantages over open donor nephrectomy. Spiral computed tomographic (CT) angiography provides accurate information of renal vascular anatomy and has become an accepted method of preoperative evaluation of potential laparoscopic renal donors. More recently, multidetector CT (MDCT) provides more detailed datasets compared with single-detector spiral CT and has been used for preoperative evaluation of laparoscopic donor nephrectomy to provide accurate anatomic information. MDCT (especially 16- and 64-slice MDCT) angiography has advantages over single-detector helical CT due to rapid scan time that allows coverage of a large volume of interest with higher spatial and temporal resolutions. In this article, we review the current status of MDCT angiography in the evaluation of laparoscopic renal donors and potential advantages of using this technology.
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Affiliation(s)
- S Kawamoto
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Johns Hopkins Outpatient Center 3235A, 601 N. Caroline Street, Baltimore, Maryland 21287, USA.
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Tsuchiya N, Satoh S, Sato K, Iinuma M, Narita S, Inoue T, Matsuura S, Habuchi T. Hand Assisted Retroperitoneoscopic Living Donor Nephrectomy in Elderly Donors. J Urol 2006; 175:230-4; discussion 234. [PMID: 16406917 DOI: 10.1016/s0022-5347(05)00043-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Revised: 05/17/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE We assessed the influence of HARDN on residual donor kidney and allograft function, invasiveness and morbidity in elderly living donors. MATERIALS AND METHODS A total of 89 living donors underwent nephrectomy before September 2004 at our institution. The 18 donors who were 65 years or older included 4 of 27 with ODN and 14 of 62 with HARDN. RESULTS In older (65 years or older) donors mean operative time, mean blood loss and warm ischemia time in the HARDN group did not differ from those in the ODN group. None of the donors had major complications. Older donors with HARDN had a tendency toward a shorter hospital stay than those with ODN. Postoperative serum creatinine in older donors with HARDN was higher than that in younger donors with HARDN, while there was no difference in postoperative serum creatinine between older donors with HARDN and those with ODN. The frequency of allograft losses tended to be higher in older than in younger kidneys (4 of 18 vs 5 of 71, p = 0.054). However, most allograft losses did not seem to be related to surgical technique. CONCLUSIONS Although further studies, especially with long-term followup, are necessary, HARDN is suggested to be safe and minimally invasive surgery even in elderly donors and to be comparable to open surgery in terms of morbidity, the residual donor kidney and allograft function.
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Affiliation(s)
- Norihiko Tsuchiya
- Department of Urology, Akita University School of Medicine, Akita, Japan
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Holden A, Smith A, Dukes P, Pilmore H, Yasutomi M. Assessment of 100 Live Potential Renal Donors for Laparoscopic Nephrectomy with Multi–Detector Row Helical CT. Radiology 2005; 237:973-80. [PMID: 16304115 DOI: 10.1148/radiol.2373041303] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively review the authors' experience with multi-detector row helical computed tomography (CT) in assessing 100 consecutive live potential renal donors. MATERIALS AND METHODS Hospital ethical committee approval was obtained; informed patient consent was not required. One hundred potential renal donors underwent multi-detector row CT assessment. Nonenhanced, arterial phase, and nephrographic phase examinations were performed. Delayed topograms were acquired to visualize the collecting system anatomy. A vascular radiologist prospectively interpreted the multi-detector row CT images. A second vascular radiologist, blinded to the initial results, retrospectively reviewed the images. Eighty candidates subsequently underwent donor nephrectomy, including 70 laparoscopic donor nephrectomies (LDNs) and 10 open donor nephrectomies (ODNs). Surgical findings served as the reference standard for 80 kidneys. The imaging findings in all 100 candidates (200 kidneys) were reviewed, although these findings were considered observational data only because there was no reference standard for 120 kidneys. RESULTS Multi-detector row CT findings predicted uncomplicated LDN in 67 of 70 patients. Small upper-pole capsular arteries arising from the distal main renal artery in two patients were not described in the multi-detector row CT report: In one patient, the arising vessels resulted in conversion to ODN because of bleeding; in the other patient, arterial reconstruction was performed. In another patient, conversion to ODN was necessary because of ongoing bleeding from an avulsed large lumbar venous tributary to the left renal vein. Observational data revealed that multiple renal arteries--most of which were accessory renal arteries--were seen in 52 (26%) kidneys. Early branching of the main renal artery was seen in 24 (12%) kidneys, and main renal arterial abnormalities were identified in six (3%). Capsular arteries were detected in 10 (5%) kidneys. Major variations in the anatomy of the main renal veins--including multiple right renal veins, a retroaortic left renal vein, and a circumaortic left renal vein--were seen in 28 (14%) kidneys. Large (>5 mm in diameter) systemic tributaries to the left renal vein were seen in 25 (25%) kidneys. There was no significant interobserver disagreement between the vascular radiologists. CONCLUSION Multi-detector row CT findings can predict successful LDN in live potential renal donors.
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Affiliation(s)
- Andrew Holden
- Department of Radiology, Auckland City Hospital, Park Rd, Grafton, Auckland, New Zealand.
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